missy2b

Of course they affect my morale. I am one of those pitiful souls who wears her feelings on her sleeve. I don't often feel insecure--I know my stuff. I can feel like a doormat, however, because I can take a lot of crap without blowing up. Last week I did one of my "can I get you anything?" queries. I was told "a cup of hot tea would be nice." After the fourth attempt and being griped at, I had to tell her that I never would have offered had I known it would be such an ordeal. (Did I mention she was on droplet isolation?) She had already screamed at me because there was poo on her collection hat and because her outpt testing schedule was not being followed. It gave me great comfort to call her the "Antichrist" outside the room. I earned it--I had her for three straight shifts when everyone else had a one shift limit. I don't care if the caregivers write down everything. At least they care. As for the other question, I am a noc nurse, so I have seen my mgr maybe half a dozen times in 3 years. We are supposed to have staff mtgs, but the mgr forgets about them most of the time, so they happen 3-4x/yr. And the counseling? I have never known anyone to go--it has an extensive wait. We have a lot of alcohol use on our unit. The RNs tend to use in the off hours. The techs, well, several have been caught under the influence of spirits. We have wonderful staff. I know several who have facilities for lack of support, but no one is so optimistic as to expect a workplace free of "those people."

If they don't, let me know so I never ever go there.

Watch out for other things, too. In stem cell transplants, we deal with lots of active CMV and also hand out quite a bit of thalidomide (cause of limbless babies). Just be careful, period.

Bless you! Hmm, in real life I am so shy I don't give advice to anyone:imbar --You don't have to do a thorough thorough bath every day, but you do need to check her skin and make sure she is turning. --Skin care. Keep it moisturized and get any skin breaks taken care of. Incontinence causes serious problems. --Mouth care. Brush or sponge swab after each meal and before bed. If dentures are rubbing, take them out. No flossing with low plts. --No nose blowing with low plts, either. --Turn, cough, deep breathe. Repeat. --Watch for fall risk. . .change in flooring, stairs, stocking feet, wet floors, etc. --Ankle pumps, butt squeezes, leg raises, ROM --Protein, protein, protein. (In my world, most everyone third spaces because albumin levels are pitiful.) Accept changing tastes and be flexible when the water she has consumed for 40 years now tastes metallic. Jello is OK, but Ensure is better. I am sleep deprived and foggy. :zzzzz Hope this helps.

I have worked everything. Most floors push you to do the three 12's. It is cheaper for them. While on orientation--say you worked F/S/S days. You get no diff on Friday, 10% Sat, and 10% Sun. After probation, you will get 30% for Sat and 30% for Sun.

1. knowledge first 2. ability/willingness to teach and learn--they will be going home eventually 3. empathy--there is a reason your head is getting bitten off 4. a smile when you don't feel like it 5. teamwork attitude--you too can catch puke and clean poo 6. ability to separate work and personal life--otherwise you will burn out quickly

Saddest--25 y/o single mother with successful tx for aplastic anemia who killed herself because her parents took her children away from her. She loved those kids soooo much and never complained during her months in the hospital because she was going to see them again. Most disgusting--Pt with no skin left from chronic GVH who emitted green ooze that had to be debrided BID. He also grew invasive aspergillus that not only went into his brain but protruded from his forehead and was the size of a small candy bar. He smoked pot and had an HIV+ wife. I covered every inch of skin I could before I went in there. Other disgusting: Another allo with GVH of everything who was DNR. Died sitting up and apparently had a bowel obstruction. The tech and I laid him down to clean him up and over a liter of feces (or something foul) came out his mouth and nose. I just sat there with the suction for over 30 minutes alternating holes.

We use it all the time--with Kytril as a premed and prn by itself. Modified doses for the elderly and renal impaired. Not nearly the confusion Phenergan can give.

I work on a BMT floor and we have APNs in both inpt and outpt. They pretty much run the joint in the outpt clinic. Docs work inpt and do office appts. I think there are 8 or 10 of them, and most majored in acute care. The others were family practice but they had hem/onc experience. When I attempted grad school, we petitioned and received an elective in Oncology Nursing. I was in the Acute Care NP program with another who was in hem/onc like me, one in radiation oncology, and one in pulmonology. We were all planning to stay in those fields. My recommendation is to get some experience as a floor nurse in oncology before attempting the APN role so you can be intimately familiar with the emergencies of cord compression, SVC syndrome, hypercalcemia, tumor lysis, SIADH, hemorrhagic cystitis, chemo extravasation ,etc. Good luck

In a bmt program that does >400 transplants a year, we have had one sick newborn (genetic problem) in 8 years, and it seems like there is always someone preggers, and most breastfeed for 8-12 months. There are risks everywhere--neuro/psych pts (who are everywhere) can easily scratch you or cause you to have a needle stick. Only you can answer this for yourself.

Wow, Nesher did a great job of describing what goes on! Way to go! Also to be avoided are areas of construction and remodeling. There are ungodly things that can be stirred up and inhaled. Eating and feeding can be expensive and precarious. Often our pts take a bite or 2 and throw things away. It can take months for the metallic taste to go away. Not to mention that the pt needs to be taking things in individual containers as much as possible when he is neuropenic. Wash hands, wear masks (not the weenie paper ones either!), walk as much as possible, eat protein, drink water, milk, juices, supplements. . . No smoking, no kids, no sick people, no water on the CVL or accessed port . . .You know the drill. Good post!

http://www.cancer.gov/cancertopics/factsheet/Sites-Types/WM It's not bad, but does need to be monitored closely. And Velcade is evil, just in case they start talking about that.

I agree. Outpatient is chaotic and takes split second decision-making and prioritizing. This ability, though crudely tested for on the ridiculous boards, is different in real life when four people are asking for you at once. Experienced RNs can fly with the autonomy, but it tends to make new grads sloppy and/or stressed out. Once you get the basics nailed down, go for it. Good luck!

Oops, didn't mean to send that. Anyway, I have played the role of a medical assistant doing vitals before they saw the doc, a triage RN, a phamacist, a nurse practitioner, a wound care specialist, and a health educator. And of course, I have also been entertainment. I have played chase and soccer, I have danced under the stars, and I have been to second base with African women who were unaccustomed to white skin and breasts in brassieres. I have eaten mysterious things and squatted to go to the bathroom while curious brown faces watched to see if I was white on the bottom, too. All you have to do is be willing. Everyone has something to give, and nursing experience is a big something. Blessings on the journey!

I've been to Ecuador, central Mexico, Senegal, Mali x2, and Peru x2. I went with my local church through the International Mission Board of the Southern Baptists and in, Peru, through an independent self-supporting ministry (http://www.villamilagro.net)